Association of conventional and electronic cigarette use with suicidality in Chinese adolescents: The moderating effect of sex and school type.

To estimate the prevalence of lifetime e-cigarette use and explore the association between lifetime conventional and electronic cigarette use with suicidality among Chinese adolescents, focusing on sex and school-type differences. A total of 22,509 students from 432 classes in 80 schools were recruited in Guangdong Province using a multistage, stratified cluster, random sampling method in 2021. Self-report questionnaires were used to collect information. Multivariable logistic regression models were performed and stratification analysis was conducted. All analyses were weighted and adjusted for the complex survey design. The weighted prevalence of lifetime e-cigarette use among adolescents in Guangdong Province was 8.7 % (4.3 % were dual users and 4.4 % were e-cigarette-only users) and 2.6 % were conventional-cigarette-only users. Lifetime e-cigarette-only users (AOR [Adjusted OR] =1.46, 95 % CI = 1.21–1.76), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.58–2.46) and dual users (AOR = 1.67, 95 % CI = 1.38–2.02) were at a higher risk of suicidal ideation than non-users. Lifetime e-cigarette-only users (AOR = 2.03, 95 % CI = 1.53–2.70), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.42–2.73), and dual users (AOR = 2.76, 95 % CI = 2.10–3.61) had a significantly higher risk of suicide attempts than non-users. After further analysis stratified by sex and school type, the associations of lifetime cigarette use patterns with suicidality slightly varied. The cross-sectional study design and self-report information. The prevalence of e-cigarettes among Chinese adolescents is concerning. Lifetime conventional and e-cigarette use were associated with suicidality among Chinese adolescents, with sex and school type moderating these associations. Targeted measures to restrict cigarette use, including new tobacco product (e-cigarette) use, among adolescents are warranted. • A large cross-sectional study of cigarette patterns and suicidality in China • E-cigarettes were associated with suicidality in Chinese adolescents. • Dual users had the highest risk of suicide attempts among cigarette users. • The association of cigarette use with suicidality varied by sex and school type. [ABSTRACT FROM AUTHOR]